Title: What are the short and long term outcomes of minimally invasive approaches (e.g., percutaenous radiological drainage, laparoscopic washout and drainage) to managing complicated diverticulitis?

Project Start Date: 1 December 2016

Completion Date: 10 July 2018

Summary:

Diverticular disease is extremely common in the UK, with a third to half of people developing the condition as they get older. The condition appears as pouches or pockets sticking out from the wall of the bowel, especially on the left side. Pain, bloating, and diarrhoea or constipation (pellet-like stools) are common symptoms.

If one of the pouches becomes infected or inflamed the condition is referred to as ‘diverticulitis’. Diverticulitis is very unpleasant but is usually treated at home with antibiotics and paracetamol. However, in some cases, diverticulitis can develop complications such as bleeding from a pouch, the formation of abscesses, or burst pouches leading to perforations of the bowel. These complications can be very severe and need emergency hospital treatment. It is not clear why some people develop serious complications from diverticulitis, which can make looking after the condition more difficult.

Diverticular disease, and diverticulitis, is a priority area for Guts UK, so a couple of years ago we funded a project in collaboration with another small charity, Bowel & Cancer Research, to Dr David Humes from the University of Nottingham.

Dr Humes wanted to find out how frequently do abscesses and perforations happen as complications of diverticulitis, and whether they are more common in men or in women, and in certain age groups. He also wanted to determine how likely people are to die following these complications. Additionally Dr Humes wanted to find out how the different treatments for complicated diverticulitis compare to each other in terms of patients needing to be readmitted to hospital or needing to undergo further surgery. He was particularly interested in finding out how do newer and/or less invasive treatments, such as using laparoscopy to drain the abdomen after perforation or remove an abscesses, compare to more invasive treatments like surgery. Understanding these issues better would help clarify who is more at risk of developing serious complications from diverticulitis.

Dr Humes looked at data from hospitals and GP surgeries in England from 2000 to 2013. He found that both abscesses and perforations had become more frequent, with a 50% increase in abscesses for all age groups, and a similar increase in perforations but only in younger people (those under the age of 55).

However Dr Humes also noted that the increased frequency of both complications seemed to be matched with an increase in the use of CT Scans (a test that creates a detailed image of the inside of the body). Dr Humes suspects that the CT Scans are picking up more cases of abscesses and perforations, which might have been missed before. However it is possible that CT Scans are picking up less severe complications and it is yet unclear what is the best way to teat this particular group of patients. These results are still too preliminary and more work needs to be done to understand the best way to treat the complications of diverticulitis.

This grant allowed us to provide much needed information to clinicians and patients on how frequently the complications of diverticular disease occur and what the consequences of these are. It also provided information on the outcomes of current treatments used to treat these complications, which better inform patients and clinicians when making decisions regarding which treatments to use.

Dr David Humes

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